A new approach to nutrition science is needed to address current food systems challenges

Food insecurity, malnutrition in all its forms, including undernutrition and diet-related chronic diseases, and the degradation of the environment are urgent challenges of the 21st century.1 These intersecting global challenges share unhealthy, unsustainable and inequitable food systems as an underlying driver.1 Food systems are not operating within a number of planetary boundaries and, at the same time, they are not providing sufficient quantity, quality and diversity of safe, affordable and nutritious foods for all.2, 3 Globally, 1 in 11 people face hunger4 and about 15% of deaths are attributable to unhealthy diets.5 It is estimated that food systems contribute to one third of global greenhouse gas emissions (key driver of climate change),6 70% of freshwater use7 and are primary drivers of the high global rate of species extinction (biodiversity loss).8 Countries like Australia are especially vulnerable to natural disasters worsened by climate change (e.g., floods, bushfires and droughts), which in turn amplify related public health issues and social inequities. For example, pollution and extreme (hot and cold) temperatures are linked with several respiratory and cardiovascular diseases.9 Climate change is also affecting food production (e.g., making it difficult for farmers to grow food), accessibility (e.g., impacting transportation), and nutritional quality (e.g., affecting fertility of soils and plants' capacity to synthesise certain nutrients).10, 11 Despite being a food exporter, Australia faces challenges in securing good nutrition for its people. It is estimated that 4%–13% of the general population, and 22%–32% of the Indigenous population, are food insecure,12 and dietary risk factors are important drivers of non-communicable diseases in Australia.13 This crisis is illustrated in several studies reported in this issue of Nutrition and Dietetics. Fry et al.14 described the effects of food insecurity on the health of Australian adults using cross-sectional, nationally representative data from the Household, Income and Labour Dynamics in Australia Survey. It was found that individuals experiencing blackouts, fits or loss of consciousness were two to six times more likely to report food insecurity than other individuals, shedding light into the broader health implications of food insecurity. Certain population groups may be at even higher risk, considering that food insecurity and health issues affect disproportionally socially or economically disadvantaged groups, including Aboriginal and Torres Strait Islander Peoples. Rosewarne et al.15 in this issue note that, although the studied Walgett Aboriginal community consumes a healthier diet compared to national data for Aboriginal and Torres Strait Islander Peoples in Australia, the community still faces significant food and water security challenges that have impacted their ability to access healthy foods. This includes the loss of fishing due to river degradation, mismanagement, and drought, and the loss of plant foods due to land clearing for agriculture, drought and limited access to land. Aboriginal and Torres Strait Islander Peoples have been living, thriving and caring for the land we now call Australia for over 65 000 years. Their connection to Country, including traditional food, land and waterways, began to be dismantled from the time of European colonisation and continues to be disrupted today, including by the effects of climate change and neocolonialism.16, 17 The growing corporate concentration and power in the global food system is a key driver of these health, sustainability and social inequities.18 A few transnational agrifood corporations exert control over land, seeds, infrastructure, machinery, and technology essential for food production, distribution and sales.18 The increased scale, commodification and massification of food production, the use of ingredients of extremely low cost, and exploitation of human and natural resources have enabled the increased availability and affordability of foods that are ultra-processed.19-21 The foods and diets we have been eating for such a long time, part of our cultures with important benefits (e.g., Mediterranean Diet—as explored by Hareer et al.22 in this issue) are now being displaced by the consumption of ultra-processed foods mass-produced by food corporations.19 Almost all foods consumed nowadays are processed in some way, but ultra-processed foods (UPFs) (their systems and dietary patterns) are quite distinct. UPFs are industrial formulations made mostly or entirely from substances extracted from foods, and additives. They are highly profitable food and drink products (low cost ingredients, long shelf-life, branded products) promoted by transnational corporations.23 UPFs are designed to be overconsumed and displace long-established dietary patterns through their increased palatability, convenience, affordability and social value given through sophisticated, and often misleading, marketing strategies. These products contain little if any whole food, such as soft drinks, fast food dishes, confectionery, industrial frozen meals and ‘fake’ meat.23 UPFs are now the main source of dietary energy in high-income countries (e.g., Canada, UK, US),24 and sales are rapidly growing in low- and middle-income countries.25 Almost half of what Australians eat is ultra-processed,26 with highest intakes among the youth (children, adolescents, young adults)27, 28 and those experiencing greater levels of disadvantage.27 Meta-analyses of large-scale population studies have shown that ultra-processed dietary patterns are associated with over 30 adverse health outcomes, including type-2 diabetes, heart diseases, depression, and mortality.29 This increases the pressure on already strained healthcare systems. Other studies also indicate the manufacture, distribution and disposal of UPFs negatively impact water, energy and land use, and significantly contribute to chemical and plastic packaging pollution and biodiversity loss.30 The displacement of culturally appropriate dietary patterns by UPFs has social and cultural implications, including the loss of culinary traditions (‘acculturation’), cooking skills, and the social connections established when cooking and consuming a meal together.19 The control of the food system by a few corporations benefiting from increased UPF supply and consumption has negative economic impacts, including pushing small and medium-sized businesses out of the market.19, 31 UPF corporations maintain dominance through political activities that influence government regulations, subsidies, and trade agreements,31 and by securing privileged access to lobbyists.32 These practices hinder efforts to implement policies that discourage UPF production and consumption and that support producers of minimally processed foods.32 Now is the time to address the problem of UPFs by capitalising on momentum for change. UPFs are increasingly being discussed by the public and in news media,33 have been incorporated into national dietary guidelines globally,34 and endorsed by United Nations' bodies (WHO, UNICEF, FAO).34, 35 Despite calls from several professional health (including nutrition) associations,36-38 Australia lacks a coordinated and strategic policy approach to addressing this problem. For example, current Australian Dietary Guidelines—a key policy tool to translate and communicate nutrition research, and to inform policy activities—do not address the specific harms of UPFs,39 as evidenced by Nguyen et al.40 in this issue of the journal. This is reflected in policy actions such as front-of-pack labelling which currently lack consideration of food processing. A paper included in this issue by Barrett et al.41 proposes a modification to the Australian Health Star Rating system to account for UPFs. This is relevant considering that 75% of UPFs have a Health Star Rating of ≥2.5 stars in Australia, which can mislead consumers into thinking these products are more nutritious than they are.42 Acknowledging UPF harms to justify their inclusion in the Australian Health Star Rating system addresses these critics. Nevertheless, reducing UPFs to fit within a nutrient-based scheme—by treating them as just one component of the algorithm like another nutrient, and not as a fundamental issue—raises concerns about the scheme's ability to effectively discourage UPF consumption. It may also divert attention from policies specifically aimed at addressing UPF systems and dietary patterns. Responding to the growing evidence of the negative impacts of UPFs and respective food systems challenges requires interdisciplinary research and cross-sectoral policy actions informed by new paradigms of nutrition science. The Nova system and its identification of UPFs has been a game changer in food and nutrition field. By drawing from life and social sciences,43 the Nova system shifts the focus from the nutrient composition of foods to a more holistic one that considers the impacts of industrial processing on dietary patterns and food systems. The system recognises that the potential health effects of foods and diets involve the food matrix and other physical, biological and chemical properties that are fundamentally altered by ultra-processing. It also recognises that a system of production and consumption prioritising low cost and high profitability is structured to drive increased UPF consumption. Promoting healthy and sustainable food systems for current and future generations is central in realising United Nations' 2030 Sustainable Development Goals.1 There is expert consensus on the urgent need to address current unhealthy, unsustainable and unequitable food systems, as evidenced by over 100 global reports.44 Such action is also the first of six ‘pillars of action’ in the United Nations' Decade of Action on Nutrition (2016–2025).1 Yet progress towards achieving this agenda has been slow. Current predominant nutrient-centric and biomedical paradigms underpinning nutrition science research, policy and practice no longer can address the complexity of contemporary food and nutrition challenges.45, 46 Responding to intertwined health, sustainability and equity issues requires a novel approach to nutrition science47-49 that: (i) acknowledges the shift in modern nutrition science from a reductionist approach to a holistic one, addressing the complexities that arise as nutrition exposures move from nutrients to foods to dietary patterns, within the ‘Food System Sustainability’ era. This also means that new methods are required to generate, synthesise and evaluate the body of nutrition evidence; (ii) considers power asymmetries in food systems and the role of UPFs in driving nutrition transition globally; and finally, (iii) integrates biological, environmental and social sciences, and culture- and context-specific, non-formal knowledge, including Indigenous knowledge. Data sharing not applicable to this article as no datasets were generated or analysed.

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